The accumulation of highly sensitized patients on waiting lists for renal transplantation is a universal problem. Because these patients have alloantibodies against many HLA alloantigens, it is difficult to find a cross-match-negative graft for them. As a result, their average waiting time is much longer than that of patients with fewer or no alloantibodies. Also, because the outcome of transplantation in highly immunized patients is generally less good, the result is a relatively great number of highly sensitized patients returned to the waiting list for retransplantation. In this paper we will deal with three topics: Why patients become highly sensitized, and what strategies are available to increase the chance of finding a donor for highly immunized patients, comprise two topics. The third is the description of a special strategy developed in our center to predict and select cross-match-negative donors for highly sensitized patients.